超声引导下微波消融联合小剂量阿帕替尼治疗肝癌的疗效

The therapeutic effect of ultrasound-guided microwave ablation combined with low-dose apatinib for treating intermediate or advanced-stage liver cancer

目的:评价超声引导下微波消融联合小剂量阿帕替尼治疗中晚期肝癌患者的疗效,探讨其应用价值。方法:将46例中晚期原发性肝癌患者分为微波消融组和联合组(微波消融联合阿帕替尼),每组各23例,观察并记录所有患者治疗前及治疗后3个月、6个月、9个月、12个月的甲胎蛋白(AFP)水平、超声造影测量的病灶大小及病灶内血流灌注情况,并对所有患者治疗随访期内的疗效进行评价。结果:消融组和联合组患者的AFP在治疗后3个月及6个月均明显降低,与治疗前比较差异有统计学意义(P<0.05),两组之间比较差异无统计学意义(P>0.05);治疗后9个月与12个月,联合组的AFP明显低于消融组,差异有统计学意义(P<0.05)。治疗后3个月及6个月,两组患者的客观缓解率(ORR)差异无统计学意义(P>0.05),6个月时联合组的疾病控制率(DCR)优于消融组,差异有统计学意义(P<0.05);治疗后9个月与12个月,联合组的ORR、DCR均明显优于消融组,差异有统计学意义(P<0.05);联合组的疾病无进展生存期(PFS)高于消融组,差异有统计学意义(Z=3.224,P<0.05)。两组之间不同时间段的肿瘤大小差异无统计学意义(P>0.05),两组患者瘤体造影增强范围术后不同时间段与治疗前相比差异有统计学意义(P<0.05);治疗前及治疗后3个月、6个月、9个月三个时间段,两组之间相同时间段瘤体造影增强范围差异无统计学意义(P>0.05),12个月时联合组的造影增强范围小于消融组,差异有统计学意义(F=4.99,P=0.31)。结论:超声引导下微波消融联合小剂量阿帕替尼治疗中晚期肝癌患者疗效明显,能有效控制中晚期肝癌的疾病进展,提高患者生存时间,具有重要的临床意义。

Objective: To evaluate the clinical value of ultrasound-guided microwave ablation(MWA) combined with low-dose apatinib for treating intermediate or advanced-stage liver cancer and discuss the clinical application.Methods:46 cases with intermediate or advanced-stage liver cancer were divided into two groups according to their treatment.Twenty-three patients were enrolled in the MWA group, and 23 in the MWA+apatinib group.AFP values, lesion size, and blood perfusion of all patients were recorded by contrast-enhanced ultrasound(CEUS) before treatment and on the 3rd, 6th, 9th, and 12th month after treatment, respectively.And the medical prognosis and safety of all patients during the treatment follow-up period also were evaluated.Results:AFP values of all patients in the two groups decreased significantly on the 3rd and 6th month after treatment.There was a statistically significant difference between AFP values after treatment and those before treatment(P<0.05),and there was no statistically difference of AFP values between the 3rd and 6th month after treatment(P>0.05).On the 9th month and 12th month of treatment, AFP values in the MWA+apatinib group were significantly lower than that in the MWA group, and the difference was statistically significant(P<0.05).On the 3rd and 6th month after treatment, the objective response rate(ORR) of the two groups was similar, with no significant difference(P>0.05).On the 6th month after treatment, the disease control rate(DCR) of the combined group was better than that of the ablation group, with a statistically significant difference(P<0.05).On the 9th and 12th month after treatment, the objective response rate ORR and DCR of the MWA+apatinib group were significantly better than those of the MWA group, and there was a statistical difference(P<0.05).The disease progression-free survival(PFS) of the MWA+apatinib group was significantly higher than that of the MWA group, and the difference was statistically significant(Z=3.224,P<0.05).There was no significant difference in lesion size(P>0.05),and there were statistically significant differences in the contrast enhancement range(P<0.05) between the two groups at different time points after and before treatment.Before and on the 3rd, 6th, and 9th month after treatment, there was no statistically significant difference in the enhancement range of tumor body radiography between the two groups at the same period(P>0.05).On the 12th month, the contrast enhancement range of the MWA+apatinib group was smaller than that of the MWA group, with a statistically significant difference(F=4.99,P=0.31).Conclusion:All patients with ultrasound-guided MWA combined low-dose apatinib have a notable curative effect for the treatment of intermediate-advanced primary liver cancer, which can effectively control disease progression and prolong patients’ survival time.It has important clinical significance.